WILMINGTON — During 2017 alone, half of the region’s private substance abuse facilities were cited for by the state for violations — and in at least one case fined for issues that led to a patient’s death.
There are about a dozen private facilities in New Hanover County, not to be confused with government-funded facilities like Coastal Horizons or RHA Behavioral Health Services. The most common violations in 2017 were failures to ensure employees had proper background checks and training.
But there were more serious violations, including serious breaches of state requirements for privacy and safety. Patients were improperly drug-tested, some didn’t receive appropriate medication, and at least one died – apparently in part because there was no policy for identifying the need for more serious care.
Both the New Hanover Court system and the Department of Social Services outsource patients to these private centers, whether as part of deferred prosecution or protective services cases. Several officials, including Chief District Judge Jay Corpening, Child Protective Services Supervisor Mary Beth Rubright, and DSS Assistant Director Wanda Marino all expressed concerns about how some facilities are run, but officials have repeatedly declined to name particular facilities with which they had concerns.
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In a 2017 interview, Rubright said, “A lot of these new places are just popping up – each one seems worse than the previous one – they aren’t treating them. These places are lining their pockets at the costs of the lives of mothers and children. I know that sounds dramatic but it’s what is happening.”
Neither the courts or DSS have authority over private facilities – but the state’s Department of Health and Human Services (DHHS) does. Over the last two years alone, the DHHS has identified dozens of issues at six facilities: Knox Counseling Services (known as Harvest of Wilmington), Launch Pad Wellness, New Hanover Metro Treatment, PORT Health Services, Reflections of Hope, and Delta Behavioral Health. All of the facilities, except PORT Health, are for-profit.
“A lot of these new places are just popping up – each one seems worse than the previous one – they aren’t treating them. These places are lining their pockets at the costs of the lives of mothers and children. I know that sounds dramatic but it’s what is happening.”
The most troubling reports focused on Reflections of Hope, where DHHS identified over 30 issues and New Hanover Metro Treatment, where the lack of a written policy was followed by the death of a patient.
“Nothing was done” – New Hanover Metro Treatment
New Hanover Metro Treatment is a methadone and suboxone clinic located behind several auto shops off Castle Hayne Road, just north of Wilmington. The clinic is owned by the Colonial Management Group, a for-profit Florida-based company that recently rebranded as New Season Treatment Centers; the company operates 65 facilities nationwide.
DHHS cited New Hanover Metro Treatment for numerous violations, but the most severe apparently led to the death of a client.
In a heavily redacted 50-page document, DHHS documents how New Hanover Metro Treatment’s failure “to develop and implement written policies for the adoption of standards that assure operational and programmatic performance” ultimately effected a patient known only as “Deceased Client #1.”
Further, according to DHHS’s review, three unnamed employees – referred to as Program Director, Registered Nurse and Certified Substance Abuse Counselor – all “failed to demonstrate knowledge, skills and abilities required by the population served.”
For months, records reveal that “missing from [DC #1]’s record was a treatment plan and drug screen note.” Between January and late September of 2017, both the counselor and the nurse repeatedly failed to notify the facility’s medical director and program director of the patient’s drug screens and deteriorating health.
According to interviews with staff conducted by DHHS, the patient promised to “cut back or stop” abusing drugs and alcohol but drug screens showed otherwise.
When interviewed by DHHS, the medical director said, “to just accept that, and then month after month see [redacted] results, and not saying anything…when I reviewed the drug screens, I was disturbed by what was in the counselor’s notes and nothing was done.”
The program director had identified problems with the counselor’s job performance during the same time period, but according to DHHS “did not provide the oversight needed to ensure that DC#1’s medical and therapeutic needs were met.”
According to DHHS’s redacted summation, the facility should have escalated the patient’s treatment to a more intensive plan, involving the medical director and other staff. But this didn’t happen. Instead, the patient’s drug and or alcohol abuse and deteriorating physical condition “went unaddressed for 8 months.”
Ultimately the patient died of hypervolemia (excess fluid in the blood), gastrointestinal bleeding and liver disease.
New Hanover Metro Treatment was fined $12,000 for the violation.
A related and possibly contributing issue was the facility’s failure to ensure that clients were not “dually enrolled” in other opioid treatment programs within 75 miles – a failure that affected the deceased patient, along with several other patients.
A DHHS interview with the program director revealed the facility’s cashier – not a counselor or administrative staff member – was made responsible for ensuring dual enrollment checks were completed. The program director blamed high turnover.
DHHS also cited New Hanover Metro Treatment for a host of other issues, including improper training and hiring procedure for staff, failure to provide adequate counseling to patients, and a long list of structural and maintenance issues.
Neither calls to New Hanover Metro Treatment or emails to New Seasons were returned. On Thursday, April 19, Director of Marketing for Colonial Management Group Cheryl Zelenak emailed to say a team was collecting information; this article will be updated if and when any additional information is provided.
Dozens of issues – Reflections of Hope
Reflections of Hope is one of Wilmington’s newest facilities, opening in August 2017. But just months after accepting its first patients, the for-profit facility ran into serious trouble. Following a two-day visit from DHHS in November, the facility was cited for at least 32 issues.
Many of those issues were apparently related to former Program Director Christie Jarrell-Smith, starting with ROH’s failure to run a background check on her for aliases, prior out of state convictions, or older charges.
According to the DHHS report, Jarrell-Smith hired her husband, Roger Smith, as a security guard. This led to several breaches of privacy, according to records. Right at the time of the DHHS inspection, ROH had terminated Jarrell-Smith, but failed to change the locks or other security measures and passwords.
Jarrell-Smith continued to act as director, leading to several incidents – including the attempted theft of hundreds of order forms for prescription opioids, which were later retrieved from her car. Records show she also generated reports from ROH’s computers including confidential information about patients.
Prior to the incident, while Jarrell-Smith was still director, DHHS noted several serious issues related to dosing and distribution of buprenorphine, an opioid used in treatment that also has abuse potential.
DHHS noted that the facility may have lacked the security required by the DEA in order to distribute buprenorphine because the hard drive of the facilities security system had been stolen (the facility initially had apporpriate security, and has since restored security service). The facility also lacked the ability to properly dispense it: using unapproved drug tests, faulty dosing methods, and improper admission methods.
DHHS cited “missing and/or questionable treatment planning” and noted missing signatures and incomplete plans, counseling notes, and absence for appropriate medical referrals.
ROH was also cited for holding counseling sessions without nursing supervision, these sessions were apparently “5-10 minutes while smoking (cigarettes) outside.”
DHHS ordered Reflections of Hope to complete a correction plan.
According to new Program Director Melissa Morris, all of the issues at Reflections of Hope stemmed directly from Jarell-Smith’s role as administrator.
“Since we’ve gotten her out of the way, everything has been rechecked, and everything is in place,” Morris said, adding that Jarell-Smith had lived in North Carolina for at least five years, so a nationwide background check wasn’t required.
However, after her termination, Morris said she discovered Jarell-Smith did have previous criminal issues. Morris added it is now the facility’s policy to do nationwide background checks on all employees, to avoid missing potential warning signs.
While New Hanover Metro Treatment and Reflections of Hope had the most severe violations, four other facilities were also cited with numerous issues.
PORT Health Services
PORT Health Services was cited for its Stepping Stone facility in downtown Wilmington. A major issue was the “failure to administer medication and perform [redacted] monitoring” as ordered by a physician. According to the DHHS, and based on PORT’s action plan responses to citations, it appears at least one patient failed to receive diabetes medication for nearly two weeks.
PORT was also cited for failing to have a staff member trained to handle drug and alcohol withdrawal and other secondary complication. The facility was also written up for maintenance issues – including the potentially dangerous storing of oxygen tanks in an unsafe location and position.
Delta Behavioral Health
Delta Behavioral was cited for the second year in a row for failure to perform adequate background checks and fingerprinting of staff.
The facility failed to check the Health Care Professional Registry for both the Administrative Director and assistant.
The facility also used unapproved drug tests for new patients and failed to train staff on what are known as alternatives to restrictive intervention techniques, the less physical approaches to handling patients that are required by law.
Launch Pad Wellness
Launch Pad was cited was for failure to use the Health Care Professional Registry, as well as for failing to have adequate staff. State law requires one substance abuse counselor for every 12 adults or six adolescents. In its response, Launch Pad staff indicated it was in the hiring process.
Knox Counseling Services, (doing business as Harvest of Wilmington)
Harvest of Wilmington, run by Knox Counseling Services, was cited for serious lapses in training, including for first aid, CPR and alternatives to restrictive interventions.
Harvest was also cited for failure to perform background checks or use the Health Care Professional Registry.
Send comments and tips to Benjamin Schachtman at email@example.com, @pcdben on Twitter, and (910) 538-2001.